Trick of Trade: Umbilical foreign body removal

Emergency physicians are constantly challenged with fishing foreign bodies out of various orifices such as ears, as shown above in an earlier Trick of the Trade using a tissue adhesive.

What do you do when an overweight person presents with the cotton portion of a Q-tip lodged in his umbilicus? Skin retractors and direct probing were unsuccessful in removing the cotton.

Trick of the Trade:
Insert a long nasal speculum (typically found in an ENT kit) to visualize the entire umbilical tract. Remove under direct visualization using forceps.

Thanks to Dr. Joseph Chong and Sari Raber (EM faculty and medical student, respectively, at University of British Columbia)